title: Protective effects of dark chocolate on endothelial function and diabetes.
abstract: OBJECTIVE
  Relationship between cocoa consumption and cardiovascular disease, particularly focusing on clinical implications resulting from the beneficial effects of cocoa consumption on endothelial function and insulin resistance. This could be of clinical relevance and may suggest the mechanistic explanation for the reduced risk of cardiovascular events reported in the different studies after cocoa intake.
  
  
  RESULTS
  Increasing evidence supports a protective effect of cocoa consumption against cardiovascular disease. Cocoa and flavonoids from cocoa have been described to improve endothelial function and insulin resistance. A proposed mechanism could be considered in the improvement of the endothelium-derived vasodilator nitric oxide by enhancing nitric oxide synthesis or by decreasing nitric oxide breakdown.
  
  
  CONCLUSIONS
  The endothelium plays a pivotal role in the arterial homeostasis, and insulin resistance is the most important pathophysiological feature in various prediabetic and diabetic states. Reduced nitric oxide bioavailability with endothelial dysfunction is considered the earliest step in the pathogenesis of atherosclerosis. Further, insulin resistance could account, at least in part, for the endothelial dysfunction. Endothelial dysfunction has been considered an important and independent predictor of future development of cardiovascular risk and events. Cocoa and flavonoids from cocoa might positively modulate these mechanisms with a putative role in cardiovascular protection.
authors.affiliation: Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Grassi
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Desideri
authors.forename: Claudio
authors.initials: C
authors.lastname: Ferri
mesh_terms: D000975:Antioxidants / Q000494:pharmacology; D002099:Cacao / Q000737:chemistry*; D002182:Candy; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000517:prevention & control; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000378:metabolism; D005419:Flavonoids / Q000494:pharmacology*; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D009569:Nitric Oxide / Q000378:metabolism
chemical_list: D000975:Antioxidants; D005419:Flavonoids; D009569:Nitric Oxide